scholarly journals Successful treatment of adult cecorectal intussusception caused by cecum cancer with mobile cecum: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Hayato Shimoyama ◽  
Kimihiko Ueno ◽  
Masahiro Samizo
Keyword(s):  
Emergency Operation ◽  
Adult Intussusception ◽  
Adjacent Segment ◽  
Lead Point ◽  
Peritoneal Reflection ◽  
Combined Procedure ◽  
Potentially Malignant ◽  
Cecum Cancer ◽  
Upper Abdominal ◽  
Mobile Cecum

Abstract Background Intussusception occurs when a segment of the bowel (the intussusceptum) telescopes into an adjacent segment (the intussuscipiens). Adult intussusception occurs rarely and often requires surgical resection for its treatment. We describe the case of an adult patient with extremely rare cecorectal intussusception treated using a novel combined transabdominal and trans-anal approach, which has not yet been reported in the literature. Case presentation A 71-year-old woman was transferred to our hospital for the treatment of upper abdominal pain. Physical examination, laboratory tests, and imaging inspections showed strangulated bowel obstruction induced by intussusception associated with the intra-rectal mass. We performed an emergency operation and treated the intussusception using a combined transabdominal and trans-anal approach. The intraoperative findings revealed bloody ascites and a potentially malignant tumor that had moved toward the anal side from peritoneal reflection. The tumor served as the lead point in the cecum with mobile cecum. After reducing the intussusception using the combined procedure, we removed the ileocecal portion. The intraoperative and histopathological findings suggested that cecum cancer with mobile cecum had caused the cecorectal intussusception. The patient had an uneventful postoperative course, except for postoperative pulmonary pneumonia. Conclusion To the best of our knowledge, this is the first reported case of adult cecorectal intussusception due to cecum cancer with mobile cecum successfully treated using the combined transabdominal and trans-anal approach. This combined procedure may be useful in treating the intussusception where the lead point is distal from the peritoneal reflection.

scholarly journals Idiopathic adult intestinal intussusception: a rare cause of an acute surgical abdomen

2020 ◽  
Vol 2020 (12) ◽  
Author(s):  
Eliot R Gange ◽  
Marco A Grieco ◽  
Scott D Myers ◽  
Timothy M Guenther
Keyword(s):  
Chronic Abdominal Pain ◽  
Definitive Treatment ◽  
Adult Intussusception ◽  
Adjacent Segment ◽  
Lead Point ◽  
Cross Sectional ◽  
Surgical Decision ◽  
Tissue Diagnosis ◽  
Cross Sectional Imaging ◽  
Surgical Decision Making

Abstract Intussusception is uncommon among adults. The condition, which is defined as a telescoping of a proximal portion of the small or large bowel into the lumen of an adjacent segment of bowel, is most commonly seen in children. Among pediatric cases, the majority is benign and treated non-operatively. However, in adults, intussusception is the result of pathologic and often malignant lead points in the majority of cases. This makes surgical resection and tissue diagnosis the only definitive treatment option. While the majority of adult intussusception cases involves a pathologic lead point, a small percentage is idiopathic, without an identifiable lead point. We present a 32-year-old man with acute on chronic abdominal pain and cross-sectional imaging that identified jejunal intussusception, which was confirmed in operating room and resected. Interestingly, no pathologic lead point was identified on pathologic review. We discuss our diagnostic approach, surgical decision making and final tissue diagnosis.

EP.FRI.543 A rare case of acute jejuno-jenual intussusception in a patient with Roux-en-Y bypass secondary to a benign polyp

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Armin Fardanesh ◽  
Jamie Powell ◽  
Maitham Al-Whouhayb
Keyword(s):  
Small Bowel ◽  
Rare Case ◽  
Exploratory Laparotomy ◽  
Lead Point ◽  
Benign Polyp ◽  
Small Bowel Intussusception ◽  
Pathological Lead Point ◽  
Malignant Lesions ◽  
Ectopic Pacemaker ◽  
Upper Abdominal

Abstract Introduction Roux-en-Y Gastric bypass (REYGB) amounts for a third of surgical bariatric interventions. Small bowel obstruction (SBO) is a long-term complication in REYGB and can be caused by intussusception of bowel, in approximately 0.5% of procedures.  Intussusception in REYBG is mostly attributed to dysmotility. This report demonstrates a rare case of intussusception in REYGB secondary to a benign polyp.  Case description A 45 year old female, three years post REYGB, presented to A&E with acute, extreme upper abdominal pain, with three days absolute constipation. She was tender on examination with normal blood tests. CT scan demonstrated small bowel intussusception. Initial concerns were of intussusception of the jejuno-jejunostomy anastomosis causing SBO.  She had an exploratory laparotomy, which confirmed intussusception, however this was 20cm distal to the jejuno-jejunostomy. Bowel was gently reduced, and deemed viable. On thorough run-through, a small segment at the transition point, was considered abnormal on palpation. This region was resected and a 1x1cm intraluminal polyp was identified as the causative lead point. The patient did well postoperatively.  Discussion Small bowel intussusception in adults is typically attributed to pathological lead point, such as benign or malignant lesions. Intussusception in REYBG is a rare but well-documented cause of intestinal obstruction, usually attributed to dysmotility, secondary to ectopic pacemaker cells particularly around anastomoses. In this case, the intussusception was caused by an unusual pathology separate from the jejuno-jejunal anastomosis. We recommend thorough examination of all adjacent bowel to exclude lesions, in this case a polyp, which could result in recurrence. 

scholarly journals Adult intussusception associated with mesenteric Meckel’s diverticulum and antimesenteric ileal polyp

2019 ◽  
Vol 12 (9) ◽  
pp. e230612
Author(s):  
Adrian K McGrath ◽  
Fatimah Suliman ◽  
Noel Thin ◽  
Ashish Rohatgi
Keyword(s):  
Small Bowel ◽  
Primary Anastomosis ◽  
Meckel’S Diverticulum ◽  
Small Bowel Resection ◽  
Meckel's Diverticulum ◽  
Adult Intussusception ◽  
Histopathological Analysis ◽  
Lead Point ◽  
Benign Polyp ◽  
Antimesenteric Border

Meckel’s diverticulum is the most common congenital abnormality affecting the gastrointestinal tract, affecting 4% of the general population. It is classically located on the antimesenteric border of the ileum within 100 cm of the ileocaecal valve. Complications may include haemorrhage, bowel obstruction, diverticulitis, perforation and malignancy. This report explores the case of intussusception in an adult, in association with a mesenteric Meckel’s diverticulum and adjacent benign polyp. A 40-year-old man presented with acute abdominal pain, affecting the central abdomen and both flanks. CT imaging revealed small bowel intussusception, with either a Meckel’s diverticulum or polyp acting as a lead point. Intraoperatively, the intussusception had already resolved; however, an inflamed outpouching was identified on the mesenteric border of the ileum, with a firm mass palpable within the bowel lumen. A 70 mm small bowel resection and primary anastomosis were performed. Histopathological analysis confirmed an inflamed Meckel’s diverticulum as well as an adjacent diverticulum comprising a benign polyp.

scholarly journals Adult Burkitt’s lymphoma presenting as intussusception: first UK case report

2017 ◽  
Vol 99 (7) ◽  
pp. e206-e208 ◽  
Author(s):  
R Simson ◽  
A Planner ◽  
Roderick Alexander
Keyword(s):  
Epigastric Pain ◽  
Recurrent Abdominal Pain ◽  
Burkitt’S Lymphoma ◽  
Right Hemicolectomy ◽  
Burkitt's Lymphoma ◽  
Adult Intussusception ◽  
Lead Point ◽  
History Of ◽  
The Uk ◽  
Specific Symptoms

Colonic intussusception is rare in adults and can present with non-specific symptoms that can make diagnosis difficult and delayed. Unlike in children, it is commonly due to a pathological lead point that is often malignant. This case is the first reported case of adult intussusception due to Burkitt's lymphoma in the UK. We describe the case of a 22-year-old woman who presented with 4-week history of intermittent epigastric pain. On the third hospital admission, the diagnosis was made by abdominal computed tomography, which showed the ‘target’ sign, suggestive of intussusception. A right hemicolectomy was performed and histology later confirmed Burkitt’s lymphoma. This case demonstrates the difficulty in diagnosing intussusception in adults, which must be considered in recurrent abdominal pain when more common causes have been ruled out. The rare diagnosis of Burkitt’s lymphoma made early diagnosis and treatment important.

scholarly journals Ileocaecal Intussusception with a Lead Point: Unusual MDCT Findings of Active Crohn’s Disease Involving the Appendix

2015 ◽  
Vol 2015 ◽  
pp. 1-4
Author(s):  
Ebru Ozan ◽  
Gokce Kaan Atac ◽  
Egemen Akincioglu ◽  
Mete Keskin ◽  
Kamil Gulpinar
Keyword(s):  
Computed Tomography ◽  
Crohn’S Disease ◽  
Gastrointestinal Tract ◽  
Crohn's Disease ◽  
Multidetector Computed Tomography ◽  
Rare Case ◽  
Adult Intussusception ◽  
Lead Point ◽  
Rare Entity ◽  
Predisposing Factor

Adult intussusception is a rare entity accounting for 1% of all bowel obstructions. Unlike intussusceptions in children, which are idiopathic in 90% of cases, adult intussusceptions have an identifiable cause (lead point) in the majority of cases. Crohn’s disease (CD) may affect any part of the gastrointestinal tract, including the appendix. It was shown to be a predisposing factor for intussusception. Here, we report a rare case of adult intussusception with a lead point, emphasizing diagnostic input of multidetector computed tomography (MDCT) in a patient with active CD that involves the appendix.

scholarly journals Jejunojejunal Intussusception Induced by a Gastrointestinal Stromal Tumor

2012 ◽  
Vol 2012 ◽  
pp. 1-3 ◽  
Author(s):  
Ali H. Zakaria ◽  
Salam Daradkeh
Keyword(s):  
Gastrointestinal Tract ◽  
Gastrointestinal Stromal Tumor ◽  
Exploratory Laparotomy ◽  
Stromal Tumor ◽  
Therapeutic Interventions ◽  
Adult Intussusception ◽  
Lead Point ◽  
Imaging Studies ◽  
High Index Of Suspicion ◽  
Intestinal Obstructions

Background. Adult intussusception is a rare entity representing less than 1% of all intestinal obstructions. Diagnosis of the condition is difficult requiring a high index of suspicion and the utilization of imaging studies, especially CT scans. Diagnostic laparoscopy and/or exploratory laparotomy can be used as a diagnostic and therapeutic intervention. In over 90% of cases, an underlying lead point is identified. In the patient described here, it was a gastrointestinal stromal tumor (GIST), a relatively rare mesenchymal tumor comprising only 0.2–1.0% of the gastrointestinal tract neoplasms and believed to originate from neoplastic transformation of the interstitial cells of Cajal. GISTs may occur anywhere along the gastrointestinal tract, but most commonly arise in the stomach and small intestine. Literature review revealed only few cases reporting GISTs as a leading point of adult's intussusception.Case Presentation. In this report, we are presenting a rare case of jejunojejunal intussusception in a 78-year-old female patient with a GIST located in the terminal jejunum being the leading point, demonstrating the importance of imaging studies, especially CT scan, laparoscopy, and exploratory laparotomy as diagnostic and therapeutic interventions.

scholarly journals A rare case of adult ileo-colic intussusception: Hamartomatous polyp as a lead point with concurrent appendiceal neurofibroma in Neurofibromatosis Type 1

2021 ◽  
pp. 199
Author(s):  
Keyword(s):  
Neurofibromatosis Type 1 ◽  
Rare Case ◽  
Incidental Finding ◽  
Neurofibromatosis Type ◽  
Adult Intussusception ◽  
Lead Point ◽  
Hamartomatous Polyp ◽  
Current Case ◽  
Operative Recovery

Intussusception is a rare cause of adult intestinal obstruction and unlike in children, adult intussusception is commonly caused by a lead point, requiring surgical intervention in most cases. Hamartomatous polyp is a non-neoplastic growth of tissue containing mature cells, distributed in an abnormal manner. It is often associated with intestinal polyposis syndromes such as Peutz-Jeghers syndrome and Juvenile polyposis. In the current case, we report an extremely rare case of ileo-colic intussusception secondary to a lead point of an isolated ileal hamartomatous polyp in an elderly gentleman with Neurofibromatosis type-1. Patient was successfully treated with ileo-colic resection involving the intussuscepted segment of bowel. There was an incidental finding of a nodule in the appendix and the histology confirmed this as a neurofibroma. Post-operative recovery of the patient was unremarkable.

scholarly journals Post appendectomy young male proffer intussusception unveiled diffuse large B-cell lymphoma non-Hodgkin lymphoma

2020 ◽  
Vol 7 (10) ◽  
pp. 3486
Author(s):  
Indrajit Anandakannan ◽  
Shanthi Ponnandai Swaminathan ◽  
Vikas Kawarat ◽  
Rajeshwari Mani ◽  
Kannan .
Keyword(s):  
B Cell ◽  
Cell Lymphoma ◽  
Laparoscopic Approach ◽  
B Cell Lymphoma ◽  
Adult Intussusception ◽  
Emergency Laparotomy ◽  
Adjacent Segment ◽  
High Grade ◽  
Large B Cell Lymphoma ◽  
Large B Cell

Intussusception is the telescoping of the proximal segment of the intestine within the lumen of the adjacent segment. Adult intussusception is rare and its aetiology differs from paediatrics. Surgery is highly recommended and challenging considering the possibility of carcinoma. Post-operative intussusception is a rare and bizarre complication. We report an 18-year old male who had undergone uncomplicated appendectomy outside the institute with missed histopathological examination (HPE) report, presented with abdominal pain for 1 week, vomiting 4 days, obstipation 1 day. On examination ovoid mass of size (12×7 cm) in right hypochondrium. A plain abdomen radiograph shows dilated bowel loops. Contrast-enhanced computed tomography (CECT) abdomen and pelvis showed telescoping of small bowel into the caecum. Suggestive of post-appendectomy intussusception causing intestinal obstruction, emergency laparotomy revealed telescoping of ileum into caecum, acting as the leading point of intussusception, proceeded with right hemicolectomy and ileo-transverse anastomosis. With blindsiding HPE defining high grade diffuse large B cell lymphoma, immunohistochemistry stains nuclear positivity for cluster of differentiation-20 (CD-20) >80%, and Ki-67 >90%. Surgery plus chemotherapy is warranted being a high-grade tumour. Surgery must be restricted to the primary tumour, with mesenteric lymph node involvement based on oncological principles. Laparoscopic approach is preferred nowadays.

scholarly journals Adult Intussusception in a Referral Hospital in Sub-Saharan Africa: Case Report and Literature Review

2021 ◽  
pp. 67-72
Author(s):  
Richard Wismayer
Keyword(s):  
Literature Review ◽  
Clinical Features ◽  
Bowel Obstruction ◽  
Treatment Options ◽  
Sub Saharan Africa ◽  
Adult Intussusception ◽  
Resected Specimen ◽  
Lead Point ◽  
Abdominal Symptoms ◽  
Sub Saharan

Introduction: Adult intussusception is a rare form of bowel obstruction which constitutes less than 5% of all cases of intussusception. In Sub-Saharan Africa, adult intussusception is not a rare cause of bowel obstruction. It is usually caused by a lead point which may be malignant in up to 50% of cases unlike childhood intussusceptions which are usually idiopathic. The author reports on a case of intussusception followed by a literature review on the pathogenesis and treatment options for intussusception in Sub-Saharan Africa. Presentation of Case: A 46 year old gentleman presented with nonspecific abdominal symptoms mainly with epigastric pain associated with vomiting. No palpable masses were felt in the abdomen. Laboratory investigations were unremarkable. At laparotomy an ileo-ileal-caecal intussusception was found and when reduced 30 cm of ileum resulted gangrenous. A limited resection of the small bowel with end-to-side anastomosis involving the viable ileum and ascending colon was carried out. A lobulated lipoma was the pathological lead point on inspection of the ileum in the resected specimen. Discussion: The atypical clinical features and pathogenesis of adult intussusception are described in the case presented. In addition, this study reviews the literature regarding the pathogensis, clinical features, diagnostic imaging modalities and treatment options of adult intussusception. Conclusions: Patients with long standing abdominal pain and vomiting should have an abdominal CT scan to achieve a clear diagnosis of intussusception. This will avoid any unnecessary delays in the operative management of this condition.

scholarly journals Jejuno-jejunal intussusception in an adult – a rare presentation of abdominal pain in the Emergency Department

2021 ◽  
Author(s):  
Ahmed Hasan Yousef Al Zaabi ◽  
Jasmine Abdulla Al Janahi ◽  
Salwa Najim Alremaithi ◽  
Balamurugan Rathinavelu ◽  
hasan qayyum
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Small Bowel ◽  
Small Bowel Resection ◽  
Adult Intussusception ◽  
Lead Point ◽  
Rare Presentation ◽  
Proximal Small Bowel ◽  
Common Diagnosis ◽  
Contrast Ct

Abstract Background Abdominal pain is a common presentation to the emergency department (ED) and the differential diagnoses is broad. Intussusception is a more common diagnosis in children, with only 5% of cases reported in adults. 80–90% of adult intussusception is due to a well-defined lesion resulting in a lead point, whereas in children, most cases are idiopathic. Adult intussusception is also more commonly associated with malignancy, compared to children. In adults, malignancy is more common in intussusception involving the large bowel compared to intussusception in the small bowel. Case presentation We present a case of a 54-year-old lady who presented to our ED with abdominal pain and vomiting. She had multiple abdominal surgeries in the past. On examination, she had epigastric and peri-umblical tenderness. In view of her persistent abdominal pain that was refractory to analgesia, she had computed tomography (CT) of the abdomen which revealed a jejuno-jejunal intussusception and proximal small bowel obstruction. The patient had an urgent laparoscopy and small bowel resection of the intussusception segment was performed. No pathological lead point was identified on imaging or intra-operatively. The patient made a full recovery post operatively. Conclusion Our case report illustrates a rare diagnosis of abdominal pain and vomiting, presenting to the Emergency Department. With increasing accessibility to CT, most cases of adult intussusception are found incidentally on contrast CT of the abdomen and pelvis. While there is no consensus on management, it is more common for adult intussusception patients to have operative intervention, compared to childhood intussusception.

Sign in / Sign up

Export Citation Format

Share Document